Dr. Victor G. Carrion is the John A. Turner, M.D. Professor and Vice-Chair of Psychiatry and Behavioral Sciences at Stanford University and Director of the Stanford Early Life Stress and Resilience Program. He is in the faculty at both Stanford University School of Medicine and Lucile Packard Children’s Hospital. His multidisciplinary research on the behavioral, academic, emotional, and biological late effects of experiencing trauma has led to the development and implementation of effective new interventions for treating children who experience traumatic stress. Using Posttraumatic Stress Disorder (PTSD) as an anchor, Dr. Carrion is investigating, through longitudinal studies, the effects of stress on developmental physiology and brain development and function.
Dr. Carrion has authored and developed the multi-modal intervention therapist guide, Cue-Centered Therapy for Youth Experiencing Posttraumatic Symptoms. Cue-Centered Therapy (CCT) is a psychosocial treatment approach for children and adolescents who have been exposed to chronic traumatic experiences. CCT derives its name from its focus on the conditioning process that results in sensitivity towards trauma-related cues. Additionally, he is the author of Neuroscience of Pediatric PTSD that examines the advances in the neuroscience of executive function, memory, emotional processing and associated features such as dissociation, self-injurious behaviors, and sleep regulation.
Dr. Carrion has published numerous peer-reviewed articles addressing the social, biological, and policy implications of violence and trauma in the lives of children. He has worked as an associate editor for the Journal of Traumatic Stress and has served as a reviewer for the National Institute of Mental Health and Mental Health and Behavioral Sciences Review Board of the Department of Veterans Affairs' Medical Research Service. His seminal findings identifying biological correlates of traumatic stress have been published in leading journals of the field such as Biological Psychiatry, Depression and Anxiety, Journal of Pediatric Psychology. Most recently, Dr. Carrion edited two published works from American Psychiatric Association titled, Assessing and Treating Youth Exposed to Traumatic Stress and Applied Mindfulness: Approaches in Mental Health for Children and Adolescents; both books serve as tools for clinicians that work with children, adolescents and transitional age youth who have experienced traumatic stress.
Dr. Carrion is a Co-Founder of the Center for Youth Wellness in San Francisco, where he served on the Board and chaired the Scientific Advisory Council. In 2011, Dr. Carrion was appointed by Vice President Kamala Harris, then California Attorney General to the Mental Health Services Oversight and Accountability Commission of the State of California, where he served as chair. Dr. Carrion has received awards from the American Academy of Child and Adolescent Psychiatry, the American Foundation for Suicide Prevention, the National Association for Research in Schizophrenia and Affective Disorders, the National Institute of Mental Health and the Silicon Valley Business Journal.
- Early Life Stress
- Brain Development
- Child and Adolescent Psychiatry
Board Certification: American Board of Psychiatry and Neurology, Psychiatry (2019)
Medical Education: Icahn School of Medicine at Mount Sinai (1991) NY
Fellowship: Stanford University Child and Adolescent Psychiatry Fellowship (1997) CA
Residency: University of Pennsylvania Health System (1995) PA
Board Certification: American Board of Psychiatry and Neurology, Child and Adolescent Psychiatry (1999)
Internship: University of Pennsylvania Health System (1992) PA
Community and International Work
Mental Health Services Oversight and Accountability Commission
Opportunities for Student Involvement
The Tipping Point Community
Opportunities for Student Involvement
Ravenswood Family Health Center, East Palo Alto, Menlo Park, Redwood City
Opportunities for Student Involvement
Center for Youth Wellness
Opportunities for Student Involvement
Student Mental Health Policy Workgroup
Opportunities for Student Involvement
Current Research and Scholarly Interests
Examines the interplay between brain development and stress vulnerability via a multi-method approach that includes psychophysiology, neuroimaging, neuroendocrinology and phenomenology. Treatment development that focuses on individual and community-based interventions for stress related conditions in children and adolescents that experience traumatic stress.
Building Resilience at Schools: Emotional and Biological Assessment and Treatment of Traumatic Stress
In the last four years alone, residents of Puerto Rico have experienced a slew of natural disasters including Hurricane Maria in 2017, earthquakes in 2019 and 2020, the continued COVID-19 pandemic from 2020-2022, and most recently Hurricane Fiona. This series of distressing events can lead to an increased need for mental health resources and trauma treatment. Furthermore, the unique single-district structure of the Puerto Rican education system allows for the efficient dissemination of potential interventions and treatment to all students. The purpose of this study is to examine two treatment conditions for educators and school-aged children in Puerto Rico experiencing burnout, fatigue, and high stress: delivery of a mindfulness-based educator curriculum and, for children who report Post Traumatic Stress Disorder (PTSD) symptomatology, delivery of the mindfulness curriculum with the additional intervention of Cue-Centered Therapy (CCT). The study has two aims: 1) To assess the efficacy of the mindfulness curriculum and of CCT in a population of students, counselors, and teachers, characterized by high stress over the last few years of natural disasters and pandemic challenges and 2) To identify genetic contributions to resilience by analyzing gene expression in students before and after the intervention. The overarching goals of the investigators' research collaboration are to improve educators' psychological well-being and children's socioemotional development when faced with high stress and adversity and to improve mental health clinicians' competence and confidence in treating children exposed to trauma by training them in CCT. The investigators' research will identify critical biopsychosocial components responsible for the cognitive, behavioral, and emotional improvement and effective implementation strategies in a large but geographically dispersed school district. The knowledge base that will result from this study will inform the implementation of trauma-informed care in school settings and with populations experiencing stress and adversity, and contribute to the investigators' understanding of the underlying biology of these interventions to provide a rationale for further development and dissemination.
Stanford is currently not accepting patients for this trial. For more information, please contact Emily Wu, 650-724-6598.
Independent Studies (5)
- Directed Reading in Psychiatry
PSYC 299 (Aut, Win, Spr, Sum)
- Graduate Research
PSYC 399 (Aut, Win, Spr, Sum)
- Medical Scholars Research
PSYC 370 (Aut, Win, Spr, Sum)
- Teaching in Psychiatry
PSYC 290 (Aut, Win, Spr, Sum)
- Undergraduate Research, Independent Study, or Directed Reading
PSYC 199 (Aut, Win, Spr, Sum)
- Directed Reading in Psychiatry
The social ecology of childhood and early life adversity.
An increasing prevalence of early childhood adversity has reached epidemic proportions, creating a public health crisis. Rather than focusing only on adverse childhood experiences (ACEs) as the main lens for understanding early childhood experiences, detailed assessments of a child's social ecology are required to assess "early life adversity." These should also include the role of positive experiences, social relationships, and resilience-promoting factors. Comprehensive assessments of a child's physical and social ecology not only require parent/caregiver surveys and clinical observations, but also include measurements of the child's physiology using biomarkers. We identify cortisol as a stress biomarker and posit that hair cortisol concentrations represent a summative and chronological record of children's exposure to adverse experiences and other contextual stressors. Future research should use a social-ecological approach to investigate the robust interactions among adverse conditions, protective factors, genetic and epigenetic influences, environmental exposures, and social policy, within the context of a child's developmental stages. These contribute to their physical health, psychiatric conditions, cognitive/executive, social, and psychological functions, lifestyle choices, and socioeconomic outcomes. Such studies must inform preventive measures, therapeutic interventions, advocacy efforts, social policy changes, and public awareness campaigns to address early life adversities and their enduring effects on human potential. IMPACT: Current research does not support the practice of using ACEs as the main lens for understanding early childhood experiences. The social ecology of early childhood provides a contextual framework for evaluating the long-term health consequences of early life adversity. Comprehensive assessments reinforced with physiological measures and/or selected biomarkers, such as hair cortisol concentrations to assess early life stress, may provide critical insights into the relationships between early adversity, stress axis regulation, and subsequent health outcomes.
View details for DOI 10.1038/s41390-020-01264-x
View details for PubMedID 33462396
Longitudinal Trajectories of Hair Cortisol: Hypothalamic-Pituitary-Adrenal Axis Dysfunction in Early Childhood.
Frontiers in pediatrics
2021; 9: 740343
The objective of this study was to examine if longitudinal trajectories of hair cortisol concentrations (HCC) measured at two or three yearly time points can identify 1-3 year old children at risk for altered hypothalamic-pituitary-adrenal (HPA)-axis function due to early life stress (ELS). HCC was measured (N = 575) in 265 children using a validated enzyme-linked immunosorbent assay. Hair was sampled in Clinic Visits (CV) centered at years 1, 2, and 3 (n = 45); 1 and 2 (n = 98); 1 and 3 (n = 27); 2 and 3 (n = 95). Log-transformed HCC values were partitioned using latent class mixed models (LCMM) to minimize the Bayesian Information Criterion. Multivariable linear mixed effects models for ln-HCC as a function of fixed effects for age in months and random effects for participants (to account for repeated measures) were generated to identify the factors associated with class membership. Children in Class 1 (n = 69; 9% Black) evidenced declining ln-HCC across early childhood, whereas Class 2 members (n = 196; 43% Black) showed mixed trajectories. LCMM with only Class 2 members revealed Class 2A (n = 17, 82% Black) with sustained high ln-HCC and Class 2B (n = 179, 40% Blacks) with mixed ln-HCC profiles. Another LCMM limited to only Class 2B members revealed Class 2B1 (n = 65, 57% Black) with declining ln-HCC values (at higher ranges than Class 1), and Class 2B2 (n = 113, 30% Black) with sustained high ln-HCC values. Class 1 may represent hair cortisol trajectories associated with adaptive HPA-axis profiles, whereas 2A, 2B1, and 2B2 may represent allostatic load with dysregulated profiles of HPA-axis function in response to varying exposures to ELS. Sequential longitudinal hair cortisol measurements revealed the allostatic load associated with ELS and the potential for developing maladaptive or dysregulated HPA-axis function in early childhood.
View details for DOI 10.3389/fped.2021.740343
View details for PubMedID 34708011
- Pediatric Posttraumatic Stress SPRINGER INTERNATIONAL PUBLISHING AG. 2018: 71–88
The moderating effects of sex on insula subdivision structure in youth with posttraumatic stress symptoms.
Depression and anxiety
2017; 34 (1): 51-58
The insula is involved in interoceptive processing, emotion awareness, and attention to salient stimuli. Research suggests that these functions are specific-albeit overlapping-within insula subdivisions. Additional studies also imply that sexual dimorphism and different rates of development occur within these subdivisions in youth. The purpose of this study was to examine potential insula subdivision structure differences in youth with PTSD symptoms as compared to controls and test sex as a moderator of these differences.Insula structure (volume, surface area, and thickness) was measured with structural magnetic resonance imaging (sMRI) and calculated using Freesurfer software. We compared insula structure across age- and sex-matched boys and girls with (30 with and 29 without) PTSD symptoms while also controlling for age and whole brain measurements.Differences were specific to the insula's anterior circular sulcus. Within this subregion, boys with PTSD symptoms demonstrated larger volume and surface area than control boys, while girls with PTSD symptoms demonstrated smaller volume and surface area than control girls.Findings indicate a potential neurobiological explanation for sex differences in youth with PTSD symptoms.
View details for DOI 10.1002/da.22577
View details for PubMedID 27862643
- Cue-Centered Therapy for Youth Experiencing Posttraumatic Symptoms- A Structured, Multi-Modal Intervention, Therapist Guide Oxford University Press. 2016
Cue-Centered Treatment for Youth Exposed to Interpersonal Violence: A Randomized Controlled Trial
JOURNAL OF TRAUMATIC STRESS
2013; 26 (6): 654-662
This study provides preliminary evidence of the feasibility and efficacy of the Stanford cue-centered treatment for reducing posttraumatic stress, depression, and anxiety in children chronically exposed to violence. Sixty-five youth aged 8–17 years were recruited from 13 schools. Participants were randomly assigned to cue-centered treatment or a waitlist control group. Assessments were conducted at 4 discrete time points. Self-report measures assessed youth symptoms of posttraumatic stress disorder (PTSD), anxiety, and depression.Self-report ratings of caregiver anxiety and depression as well as caregiver report of child PTSD were also obtained. Therapists evaluated participants’ overall symptom improvement across treatment sessions. Hierarchal linear modeling analyses showed that compared to the waitlist group, the cue-centered treatment group had greater reductions in PTSD symptoms both by caregiver and child report, as well as caregiver anxiety. Cue-centered treatment, a hybrid trauma intervention merging diverse theoretical approaches, demonstrated feasibility,adherence, and efficacy in treating youth with a history of interpersonal violence.
View details for DOI 10.1002/jts.21870
View details for Web of Science ID 000328566900002
View details for PubMedID 24490236
- Stressing about posttraumatic stress disorder - In reply PEDIATRICS 2007; 120 (1): 234–35
Verbal declarative memory in pediatric PTSD: An fMRI study
ELSEVIER SCIENCE INC. 2006: 248S
View details for Web of Science ID 000236767301384
Resilience by design: How nature, nurture, environment, and microbiome mitigate stress and allostatic load.
World journal of psychiatry
2023; 13 (5): 144-159
Resilience to psychological stress is defined as adaption to challenging life experiences and not the absence of adverse life events. Determinants of resilience include personality traits, genetic/epigenetic modifications of genes involved in the stress response, cognitive and behavioral flexibility, secure attachment with a caregiver, social and community support systems, nutrition and exercise, and alignment of circadian rhythm to the natural light/dark cycle. Therefore, resilience is a dynamic and flexible process that continually evolves by the intersection of different domains in human's life; biological, social, and psychological. The objective of this minireview is to summarize the existing knowledge about the multitude factors and molecular alterations that result from resilience to stress response. Given the multiple contributing factors in building resilience, we set out a goal to identify which factors were most supportive of a causal role by the current literature. We focused on resilience-related molecular alterations resulting from mind-body homeostasis in connection with psychosocial and environmental factors. We conclude that there is no one causal factor that differentiates a resilient person from a vulnerable one. Instead, building resilience requires an intricate network of positive experiences and a healthy lifestyle that contribute to a balanced mind-body connection. Therefore, a holistic approach must be adopted in future research on stress response to address the multiple elements that promote resilience and prevent illnesses and psychopathology related to stress allostatic load.
View details for DOI 10.5498/wjp.v13.i5.144
View details for PubMedID 37303926
View details for PubMedCentralID PMC10251360
Structural equation modeling of treatment-related changes in neural connectivity for youth with PTSD.
Journal of affective disorders
Previous studies suggest that improvement in symptoms of posttraumatic stress disorder (PTSD) is accompanied by changes in neural connectivity, however, few studies have investigated directional (effective) connectivity. The current study assesses treatment-related changes in effective connectivity in youth with PTSD undergoing Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).Functional MRI scans before and after 16 weeks of TF-CBT for 20 youth with PTSD, or the same time interval for 20 healthy controls (HC) were included in the analysis. Structural equation modeling was used to model group differences in directional connectivity at baseline, and changes in connectivity from pre- to post-treatment.At baseline, the PTSD group, relative to the HC group, had significantly greater connectivity in the path from dorsal cingulate to anterior cingulate and from dorsal cingulate to posterior cingulate corticies. From pre- to post-treatment, connectivity in these paths decreased significantly in the PTSD group, as did connectivity from right hippocampus to left superior temporal gyrus. Connectivity from the left amygdala to the lateral orbital frontal cortex was significantly lower in PTSD vs HC at baseline, but did not change from pre- to post-treatment.Although based on a small sample, these results converge with previous studies in suggesting a central role for the dorsal cingulate cortex in PTSD symptoms. The direction of this connectivity suggests that the dorsal cingulate is the source of modulation of anterior and posterior cingulate cortex during trauma-focused cognitive behavioral therapy.
View details for DOI 10.1016/j.jad.2023.04.066
View details for PubMedID 37127117
Cortical activation predicts posttraumatic improvement in youth treated with TF-CBT or CCT.
Journal of psychiatric research
2022; 156: 25-35
BACKGROUND: Identifying neural activation patterns that predict youths' treatment response may aid in the development of imaging-based assessment of emotion dysregulation following trauma and foster tailored intervention. Changes in cortical hemodynamic activity measured with functional near-infrared spectroscopy (fNIRS) may provide a time and cost-effective option for such work. We examined youths' PTSD symptom change following treatment and tested if previously identified activation patterns would predict treatment response.METHODS: Youth (N=73, mean age=12.97, SD=3.09 years) were randomly assigned to trauma-focused cognitive behavioral therapy (TF-CBT), cue-centered therapy (CCT), or treatment as usual (TAU). Parents and youth reported on youth's PTSD symptoms at pre-intervention, post-intervention, and follow-up. Neuroimaging data (N=31) assessed at pre-intervention were obtained while youth engaged in an emotion expression task. Treatment response slopes were calculated for youth's PTSD symptoms.RESULTS: Overall, PTSD symptoms decreased from pre-intervention through follow-up across conditions, with some evidence of relative benefit of TF-CBT and CCT over TAU but significant individual variation in treatment response. Cortical activation patterns were correlated with PTSD symptom improvement slopes (r=0.53). In particular, cortical responses to fearful and neutral facial stimuli in six fNIRS channels in the bilateral dlPFC were important predictors of PTSD symptom improvement.CONCLUSIONS: The use of fNIRS provides a method of monitoring and assessing cortical activation patterns in a relatively inexpensive and portable manner. Associations between functional activation and youths' PTSD symptoms improvement may be a promising avenue for understanding emotion dysregulation in clinical populations.
View details for DOI 10.1016/j.jpsychires.2022.10.002
View details for PubMedID 36228389
Impact of anxiety and depression on academic achievement among underserved school children: evidence of suppressor effects
Anxiety and depression symptoms may leave children at risk for lower academic scores, though this unique linkage to academic achievement in underserved youth is less well established. This study aimed to examine how anxiety and depression are uniquely related to spelling and math achievement beyond attention and hyperactivity deficits in children in underserved schools. Children aged 8 to 11 (n = 1085, 47.3% female) from historically underserved groups (Hispanic 75.3%, American Indian 6.4%, Black 4.9%, and White 1.5%) from 13 schools across two public school districts in California participated in the assessment of emotional and behavioral health symptoms that included a spelling and math assessment. While there was no relationship between anxiety or hyperactivity on spelling and math scores, depression and attention problems were significantly negatively related to spelling and math scores. However, when entered simultaneously, evidence of suppressor effects emerged. Anxiety and hyperactivity both became positively predictive of math. Similarly, anxiety became positively predictive of spelling. Subsample analyses showed that these suppressor effects were only in females. The associations among anxiety, depression, attention, and hyperactivity with spelling and math achievement are complex, and when controlling for depression and attention, anxiety levels and hyperactivity may be motivating some level of achievement in these areas.
View details for DOI 10.1007/s12144-022-03801-9
View details for Web of Science ID 000862207300004
View details for PubMedID 36213567
View details for PubMedCentralID PMC9524334
Functional near-infrared spectroscopy brain imaging predicts symptom severity in youth exposed to traumatic stress.
Journal of psychiatric research
2021; 144: 494-502
Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique with the potential to enable the assessment of posttraumatic stress disorder (PTSD) brain biomarkers in an affordable and portable manner. Consistent with biological models of PTSD, functional magnetic resonance imaging (fMRI) and fNIRS studies of adults with trauma exposure and PTSD symptoms suggest increased activation in the dorsolateral prefrontal cortex (dlPFC) and ventrolateral PFC (vlPFC) in response to negative emotion stimuli. We tested this theory with fNIRS assessment among youth exposed to traumatic stress and experiencing PTSD symptoms (PTSS). A portable fNIRS system collected hemodynamic responses from (N=57) youth with PTSS when engaging in a classic emotion expression task that included fearful and neutral faces stimuli. The General Linear Model was applied to identify cortical activations associated with the facial stimuli. Subsequently, a prediction model was established via a Support Vector Regression to determine whether PTSS severity could be predicted based on fNIRS-derived cortical response measures and individual demographic information. Results were consistent with findings from adult fMRI and fNIRS studies of PTSS showing increased activation in the dlPFC and vlPFC in response to negative emotion stimuli. Subsequent prediction analysis revealed ten features (i.e., cortical responses from eight frontocortical fNIRS channels, age and sex) strongly correlated with PTSS severity (r=0.65, p<.001). Our findings suggest the potential utility of fNIRS as a portable tool for the detection of putative PTSS brain biomarkers.
View details for DOI 10.1016/j.jpsychires.2021.10.020
View details for PubMedID 34768071
A school-based health and mindfulness curriculum improves children's objectively measured sleep: a prospective observational cohort study.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
STUDY OBJECTIVES: Poor sleep impedes children's cognitive, emotional, and psychosocial development. Pediatric sleep dysregulation is common, and children who live in communities of low socioeconomic status (SES) experience additional risk factors for short sleep duration and poor sleep quality. School-based training in mindfulness and yoga-informed practices can improve children's behavior and well-being, but effects on objectively measured sleep are unknown.METHODS: Effects of a school-based health and mindfulness curriculum, which taught practices such as paced breathing, on sleep and stress were examined in 115 children (49 girls, ages eight to 11 at baseline). 58 children in a community of low socioeconomic status (SES) received the curriculum twice weekly for two years. 57 children in an SES-matched community engaged in their usual physical education class instead. In-home ambulatory polysomnography and perceived social stress were measured from all children at three timepoints: at baseline (i.e., prior to curriculum exposure) and at two yearly follow-ups.RESULTS: Children receiving the curriculum gained an average of 74 minutes of total sleep time, and 24 minutes of rapid eye movement (REM) sleep, per night over the two-year study period. Children not receiving the curriculum experienced a decrease in total sleep time averaging 64 minutes per night, with no changes in REM sleep. Sleep improved within the first three months of curriculum exposure, in a dose-dependent fashion. Higher curriculum engagement (e.g., using the breathing exercises outside of class) was associated with larger gains in total and REM sleep duration. Aggregate within-group changes in social stress were not significant. However, among children receiving the curriculum, those who experienced larger gains in total and REM sleep duration also experienced larger increases in perceived social stress.CONCLUSIONS: A school-based health and mindfulness curriculum improved children's objectively measured sleep over two years. Social stress did not mediate these effects; instead, mindfulness training may have increased awareness of environmental stressors, while developing tools to reduce stress vulnerability.
View details for DOI 10.5664/jcsm.9508
View details for PubMedID 34170222
A SCHOOL-BASED HEALTH AND MINDFULNESS CURRICULUM IMPROVES CHILDREN'S OBJECTIVELY MEASURED SLEEP
OXFORD UNIV PRESS INC. 2021: A251
View details for Web of Science ID 000698984300640
Changes in Brain Volume Associated with Trauma-Focused Cognitive Behavioral Therapy Among Youth with Posttraumatic Stress Disorder.
Journal of traumatic stress
This study investigated group differences and longitudinal changes in brain volume before and after trauma-focused cognitive behavioral therapy (TF-CBT) in 20 unmedicated youth with maltreatment-related posttraumatic stress disorder (PTSD) and 20 non-trauma-exposed healthy control (HC) participants. We collected MRI scans of brain anatomy before and after 5 months of TF-CBT or the same time interval for the HC group. FreeSurfer software was used to segment brain images into 95 cortical and subcortical volumes, which were submitted to optimal scaling regression with lasso variable selection. The resulting model of group differences at baseline included larger right medial orbital frontal and left posterior cingulate corticies and smaller right midcingulate and right precuneus corticies in the PTSD relative to the HC group, R2 = .67. The model of group differences in pre- to posttreatment change included greater longitudinal changes in right rostral middle frontal, left pars triangularis, right entorhinal, and left cuneus corticies in the PTSD relative to the HC group, R2 = .69. Within the PTSD group, pre- to posttreatment symptom improvement was modeled by longitudinal decreases in the left posterior cingulate cortex, R2 = .45, and predicted by baseline measures of a smaller right isthmus (retrosplenial) cingulate and larger left caudate, R2 = .77. In sum, treatment was associated with longitudinal changes in brain regions that support executive functioning but not those that discriminated PTSD from HC participants at baseline. Additionally, results confirm a role for the posterior/retrosplenial cingulate as a correlate of PTSD symptom improvement and predictor of treatment outcome.
View details for DOI 10.1002/jts.22678
View details for PubMedID 33881197
Cue-Centered Therapy for Youth Experiencing Posttraumatic Symptoms.
Current treatment options in psychiatry
Purpose: Few of the existing evidence-based interventions for child trauma exposure were specifically designed to address experiences and outcomes of complex developmental trauma. Stanford's cue-centered therapy (CCT) was designed to address this gap by offering a flexible, integrative, and insight-oriented treatment approach that is grounded in principles of neuroscience, developmental trauma, client empowerment, and allostasis. This article reviews the CCT rationale, treatment components, evidence base, and training approach.Recent findings: Studies demonstrate promising outcomes indicating CCT effectiveness in reducing child and caregiver posttraumatic stress, and in improving child functioning. Further research, however, is needed to identify which clients are best-suited for CCT (versus other available child trauma treatments) and to identify which components of CCT are most critical for addressing complex developmental trauma.Summary: CCT advances the field of child trauma treatment by offering an intervention approach focused on addressing complex developmental trauma. Positive treatment and training outcomes indicate utility of CCT for clients and clinicians. Innovations in research and training approaches are needed to further dissemination and implementation of CCT and other related child trauma interventions for complex developmental trauma.
View details for DOI 10.1007/s40501-021-00241-3
View details for PubMedID 33898161
Translating the neuroscience of adverse childhood experiences to inform policy and foster population-level resilience.
The American psychologist
2021; 76 (2): 188–202
Imaging methods have elucidated several neurobiological correlates of traumatic and adverse experiences in childhood. This knowledge base may foster the development of programs and policies that aim to build resilience and adaptation in children and youth facing adversity. Translation of this research requires both effective and accurate communication of the science. This review begins with a discussion of integrating the language used to describe and identify childhood adversity and their outcomes to clarify the translation of neurodevelopmental findings. An integrative term, Traumatic and Adverse Childhood Experiences (TRACEs+) is proposed, alongside a revised adverse childhood experiences (ACEs) pyramid that emphasizes that a diversity of adverse experiences may lead to a common outcome and that a diversity of outcomes may result from a common adverse experience. This term facilitates linkages between the ACEs literature and the emerging neurodevelopmental knowledge surrounding the effect of traumatic adverse childhood experiences on youth in terms of the knowns and unknowns about neural connectivity in youth samples. How neuroscience findings may lead directly or indirectly to specific techniques or targets for intervention and the reciprocal nature of these relationships is addressed. Potential implications of the neuroscience for policy and intervention at multiple levels are illustrated using existing policy programs that may be informed by (and inform) neuroscience. The need for transdisciplinary models to continue to move the science to action closes the article. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
View details for DOI 10.1037/amp0000780
View details for PubMedID 33734788
- CUE-CENTERED THERAPY IN COMMUNITY SETTINGS ELSEVIER SCIENCE INC. 2020: S323
- Measuring the Fidelity of a School-Based Yoga and Mindfulness Curriculum for Youth: A Transdisciplinary Feasibility Study CHILD & YOUTH CARE FORUM 2020
Anxiety and Stress Alter Decision-Making Dynamics and Causal Amygdala-Dorsolateral Prefrontal Cortex Circuits During Emotion Regulation in Children.
Anxiety and stress reactivity are risk factors for the development of affective disorders. However, the behavioral and neurocircuit mechanisms that potentiate maladaptive emotion regulation are poorly understood. Neuroimaging studies have implicated the amygdala and dorsolateral prefrontal cortex (DLPFC) in emotion regulation, but how anxiety and stress alter their context-specific causal circuit interactions is not known. Here, we use computational modeling to inform affective pathophysiology, etiology, and neurocircuit targets for early intervention.Forty-five children (10-11 years of age; 25 boys) reappraised aversive stimuli during functional magnetic resonance imaging scanning. Clinical measures of anxiety and stress were acquired for each child. Drift-diffusion modeling of behavioral data and causal circuit analysis of functional magnetic resonance imaging data, with a National Institute of Mental Health Research Domain Criteria approach, were used to characterize latent behavioral and neurocircuit decision-making dynamics driving emotion regulation.Children successfully reappraised negative responses to aversive stimuli. Drift-diffusion modeling revealed that emotion regulation was characterized by increased initial bias toward positive reactivity during viewing of aversive stimuli and increased drift rate, which captured evidence accumulation during emotion evaluation. Crucially, anxiety and stress reactivity impaired latent behavioral dynamics associated with reappraisal and decision making. Anxiety and stress increased dynamic casual influences from the right amygdala to DLPFC. In contrast, DLPFC, but not amygdala, reactivity was correlated with evidence accumulation and decision making during emotion reappraisal.Our findings provide new insights into how anxiety and stress in children impact decision making and amygdala-DLPFC signaling during emotion regulation, and uncover latent behavioral and neurocircuit mechanisms of early risk for psychopathology.
View details for DOI 10.1016/j.biopsych.2020.02.011
View details for PubMedID 32331823
Functional neuroanatomy of interoceptive processing in children and adolescents: a pilot study.
2019; 9 (1): 16184
In adults, interoception - the sense of the physiological condition of the body - appears to influence emotion processing, cognition, behavior and various somatic and mental health disorders. Adults demonstrate frontal-insula-parietal-anterior cingulate cortex activation during the heartbeat detection task, a common interoceptive measure. Little, however, is known about the functional neuroanatomy underlying interoception in children. The current pilot study examined interoceptive processing in children and adolescents with fMRI while using the heartbeat detection task. Our main findings demonstrate that children as young as the age of six activate the left insula, cuneus, inferior parietal lobule and prefrontal regions. These findings are similar to those in adults when comparing heartbeat and tone detection conditions. Age was associated with increased activation within the dACC, orbital frontal cortex and the mid-inferior frontal gyri. Thus, our pilot study may provide important information about the neurodevelopment of interoceptive processing abilities in children and a task for future interoception neuroimaging studies in children.
View details for DOI 10.1038/s41598-019-52776-4
View details for PubMedID 31700095
Hyperdirect insula-basal-ganglia pathway and adult-like maturity of global brain responses predict inhibitory control in children.
2019; 10 (1): 4798
Inhibitory control is fundamental to children's self-regulation and cognitive development. Here we investigate cortical-basal ganglia pathways underlying inhibitory control in children and their adult-like maturity. We first conduct a comprehensive meta-analysis of extant neurodevelopmental studies of inhibitory control and highlight important gaps in the literature. Second, we examine cortical-basal ganglia activation during inhibitory control in children ages 9-12 and demonstrate the formation of an adult-like inhibitory control network by late childhood. Third, we develop a neural maturation index (NMI), which assesses the similarity of brain activation patterns between children and adults, and demonstrate that higher NMI in children predicts better inhibitory control. Fourth, we show that activity in the subthalamic nucleus and its effective connectivity with the right anterior insula predicts children's inhibitory control. Fifth, we replicate our findings across multiple cohorts. Our findings provide insights into cortical-basal ganglia circuits and global brain organization underlying the development of inhibitory control.
View details for DOI 10.1038/s41467-019-12756-8
View details for PubMedID 31641118
Longitudinal changes in brain function associated with symptom improvement in youth with PTSD.
Journal of psychiatric research
2019; 114: 161–69
BACKGROUND: Previous studies indicate that youth with posttraumatic stress disorder (PTSD) have abnormal activation in brain regions important for emotion processing. It is unknown whether symptom improvement is accompanied by normative changes in these regions. This study identified neural changes associated with symptom improvement with the long-term goal of identifying malleable targets for interventions.METHODS: A total of 80 functional magnetic resonance imaging (fMRI) scans were collected, including 20 adolescents with PTSD (ages 9-17) and 20 age- and sex-matched healthy control subjects, each scanned before and after a 5-month period. Trauma-focused cognitive behavioral therapy was provided to the PTSD group to ensure improvement in symptoms. Whole brain voxel-wise activation and region of interest analyses of facial expression task data were conducted to identify abnormalities in the PTSD group versus HC at baseline (BL), and neural changes correlated with symptom improvement from BL to EOS of study (EOS).RESULTS: At BL, the PTSD group had abnormally elevated activation in the cingulate cortex, hippocampus, amygdala, and medial frontal cortex compared to HC. From BL to EOS, PTSD symptoms improved an average of 39%. Longitudinal improvement in symptoms of PTSD was associated with decreasing activation in posterior cingulate, mid-cingulate, and hippocampus, while improvement in dissociative symptoms was correlated with decreasing activation in the amygdala.CONCLUSIONS: Abnormalities in emotion-processing brain networks in youth with PTSD normalize when symptoms improve, demonstrating neural plasticity of these regions in young patients and the importance of early intervention.
View details for PubMedID 31082658
ASSESSING AND TREATING YOUTH EXPOSED to Traumatic Stress Preface
ASSESSING AND TREATING YOUTH EXPOSED TO TRAUMATIC STRESS
View details for Web of Science ID 000549804100001
Transdiagnostic Treatment for Youth with Traumatic Stress
INNOVATIONS IN CBT FOR CHILDHOOD ANXIETY, OCD, AND PTSD
View details for Web of Science ID 000654419100034
- THE IMPORTANCE OF TRAUMA AND ADVERSITY IN THE TREATMENT OF CHILD PSYCHIATRIC DISORDERS ELSEVIER SCIENCE INC. 2018: S57–S58
The Network Structure of Posttraumatic Stress Symptoms in Children and Adolescents Exposed to Disasters
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
2017; 56 (8): 669–77
To evaluate current theoretical assumptions about the nature of pediatric posttraumatic stress disorder (PTSD) by examining the network structure of PTSD in a sample of youth exposed to disasters and testing for age differences. Network analysis provides the opportunity to identify "central" symptoms that might hold an outsized influence over others and are important targets for research and treatment. The authors hypothesized that particular symptoms would exhibit greater influence over others. They further hypothesized marked differences in symptom networks across children and adolescents.Participants were 786 youth 8 to 13 years old (children) and 14 to 18 years old (adolescents) exposed to Hurricanes Katrina and Gustav who were assessed for PTSD symptoms using the University of California-Los Angeles PTSD Reaction Index for Children. Network models were computed and constructed using the R-package qgraph, which estimates associations between symptoms and forms graphic network models.Consistent with the hypotheses, the symptom network demonstrated meaningful variability across age, particularly in the strength of associations, and the relative importance of individual symptoms to the network as a whole. Results further demonstrated that symptoms cluster together in a manner that adds a unique perspective to current model conceptualizations.Network analysis is a potentially important additional conceptualization of psychopathology with related data analytic techniques. Results suggest that PTSD can be characterized as a web of interactions between symptoms. This work illuminates differences in the PTSD symptom network across development, such as the link between numbness of negative affect and amnesia in children, but not in teens, and how the critical symptoms within that network differ across childhood and adolescence. Network analysis could allow the re-envisioning of the nature of this complex disorder with new avenues for research and clinical practice.
View details for PubMedID 28735696
Post-traumatic stress and age variation in amygdala volumes among youth exposed to trauma.
Social cognitive and affective neuroscience
2015; 10 (12): 1661-1667
Theoretically, normal developmental variation in amygdala volumes may be altered under conditions of severe stress. The purpose of this article was to examine whether posttraumatic stress moderates the association between age and amygdala volumes in youth exposed to traumatic events who are experiencing symptoms of post-traumatic stress disorder (PTSD). Volumetric imaging was conducted on two groups of youth aged 9-17 years: 28 with exposure to trauma and PTSD symptoms (boys = 15, girls = 13) and 26 matched (age, IQ) comparison youth (Controls; boys = 12, girls = 14). There was a significant group by age interaction in predicting right amygdala volumes. A positive association between age and right amygdala volumes was observed, but only in PTSD youth. These associations with age remained when controlling for IQ, total brain volumes and sex. Moreover, older youth with PTSD symptoms had relatively larger right amygdala volumes than controls. Findings provide evidence that severe stress may influence age-related variation in amygdala volumes. Results further highlight the importance of utilizing age as an interactive variable in pediatric neuroimaging research, in so far as age may act as an important moderator of group differences.
View details for DOI 10.1093/scan/nsv053
View details for PubMedID 25964500
Child abuse, disruptive behavior disorders, depression, and salivary cortisol levels among institutionalized and community-residing boys in Mongolia
2015; 7 (1): 7-19
Hypothalamic-pituitary-adrenal (HPA) axis activity is related to childhood disruptive behavior disorders and to exposure to abuse and neglect. This study explores the relationship of diurnal salivary cortisol levels with oppositional defiant disorder (ODD) and caregiver attitudes toward physical punishment among boys in Mongolia.Salivary cortisol was collected in the home or institution 4 times daily for 4 days from 46 boys, aged 4-10 years, in Ulaanbaatar, Mongolia. Caregivers rated child disruptive behavior symptoms, attitudes toward physical punishment, and community violence exposures. Mixed effects models were used to estimate the association of psychopathology and caregiver attitudes with salivary cortisol levels.Boys meeting criteria for ODD displayed consistently lower diurnal salivary cortisol levels compared to boys without ODD diagnoses. Controlling for ODD diagnosis, boys with depression showed higher cortisol levels throughout the day. No other diagnosis was associated with cortisol levels. Psychiatric diagnosis accounted for 17% of between individual variations in cortisol levels unexplained by the covariates. In a separate model, caregivers' beliefs regarding physical punishment accounted for 11% of between individual differences: boys with caregivers who stated physical punishment was necessary for discipline displayed hypocortisolism. Institutionalization did not associate with cortisol levels.Salivary cortisol data from a non-Western naturalistic setting support an association of reduced basal HPA activity with disruptive behavior disorders and caregiver attitudes toward discipline. These findings suggest HPA functioning may be a reflection of or mediate disruptive behavior disorders in children across ethnic and cultural settings.
View details for DOI 10.1111/appy.12141
View details for Web of Science ID 000349981000002
View details for PubMedID 24890783
Insula Measures and Emotional Cognitive Interplay in Youth with Post-Traumatic Stress Symptoms: Does Gender Matter?
ELSEVIER SCIENCE INC. 2014: 285S–286S
View details for Web of Science ID 000334101802034
- Integrated Behavioral Health Services: A Collaborative Care Model for Pediatric Patients in a Low-Income Setting CLINICAL PEDIATRICS 2013; 52 (12): 1178-1180
Developmental Variation in Amygdala Volumes Among Children With Posttraumatic Stress
2013; 38 (7): 481-495
This article examined associations between indices of maturation (age and Tanner stage) and amygdala volumes in 24 youth (aged 7-14) with posttraumatic stress disorder symptoms and a matched control group. Fifteen of the youth with exposure to trauma were also re-evaluated one year later. A positive association between maturation and right amygdala volumes was observed in the trauma group but not in controls. Associations with maturation remained when controlling for a number of possible covariates and over time. Developmentally younger youth (Tanner stage 1 and 2) showed increases and older (Tanner stage 3 and 4) decreases in right amygdala volumes.
View details for DOI 10.1080/87565641.2013.820307
View details for Web of Science ID 000326069700004
View details for PubMedID 24138217
- Introduction to a Special Issue on Research with Youth Exposed to Disasters and Violence CHILD & YOUTH CARE FORUM 2013; 42 (4): 257-259
- Helping Children Exposed to War and Violence: Perspectives from an International Work Group on Interventions for Youth and Families CHILD & YOUTH CARE FORUM 2013; 42 (4): 371-388
A Prospective Study on the Association Between Caregiver Psychological Symptomatology and Symptom Clusters of Pediatric Posttraumatic Stress Disorder
JOURNAL OF TRAUMATIC STRESS
2013; 26 (3): 385-391
This study investigated the influence of caregiver psychological symptoms on posttraumatic stress disorder (PTSD) symptoms in traumatized children. One-hundred eleven children and caretakers were assessed in this study. Children (N = 59) with a history of exposure to interpersonal violence were evaluated for reexperiencing, avoidance/numbing, and hyperarousal symptom clusters using the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). The 52 primary caregivers were evaluated using the Symptom Checklist-90-Revised (SCL-90-R) on 9 domains of psychological symptomatology: anxiety, depression, hostility, interpersonal sensitivity, obsessive-compulsive disorder, paranoid ideation, phobic anxiety, psychoticism, and somatization. At 14-month follow-up, 45 of the children were re-evaluated with the CAPS-CA. Caregiver psychological symptoms in the domains of anxiety, depression, interpersonal sensitivity, obsessive-compulsive disorder, and paranoid ideation were associated with less improvement in total pediatric PTSD symptoms. Analysis of PTSD symptoms by cluster showed that greater caregiver symptomatology in the domains of anxiety, depression, interpersonal sensitivity, and obsessive-compulsive disorder were associated with less improvement in the hyperarousal symptom cluster. These results suggest caregiver symptomatology may be specifically associated with hyperarousal symptoms in pediatric trauma.
View details for DOI 10.1002/jts.21816
View details for PubMedID 23737297
Sleep Disturbance in Pediatric PTSD: Current Findings and Future Directions.
Journal of clinical sleep medicine
2013; 9 (5): 501-510
Many studies have provided strong evidence of a fundamental and complex role for sleep disturbances in adult posttraumatic stress disorder (PTSD). Investigations of adult PTSD using subjective and objective measures document sleep architecture abnormalities and high prevalence of sleep disordered breathing, periodic limb movement disorder, nightmares, and insomnia. PTSD treatment methods do appear to significantly improve sleep disturbance, and also studies suggest that treatments for sleep disorders often result in improvements in PTSD symptoms. Further, the most recent evidence suggests sleep abnormalities may precede the development of PTSD. Given the importance of sleep disorders to the onset, course, and treatment of adult PTSD, examination of sleep disturbances far earlier in the life course is imperative. Here we review the literature on what we know about sleep disturbances and disorders in pediatric PTSD. Our review indicates that the extant, empirical data examining sleep disturbance and disorders in pediatric PTSD is limited. Yet, this literature suggests there are significantly higher reports of sleep disturbances and nightmares in children and adolescents exposed to trauma and/or diagnosed with PTSD than in non-trauma-exposed samples. Sleep questionnaires are predominantly employed to assess sleep disorders in pediatric PTSD, with few studies utilizing objective measures. Given the important, complex relationship being uncovered between adult PTSD and sleep, this review calls for further research of sleep in children with PTSD using more specific subjective measures and also objective measures, such as polysomnography and eventually treatment trial studies. CITATION: Kovachy B; O'Hara R; Hawkins N; Gershon A; Primeau MM; Madej J; Carrion V. Sleep disturbance in pediatric PTSD: current findings and future directions. J Clin Sleep Med 2013;9(5):501-510.
View details for DOI 10.5664/jcsm.2678
View details for PubMedID 23674943
View details for PubMedCentralID PMC3629326
- The interrelation of adverse childhood experiences within an at-risk pediatric sample Journal of Child & Adolescent Trauma 2013; 6: 217-229
- Adverse childhood experiences among at-risk youth: The interrelation of ACES within a pediatric sample Journal of Child & Adolescent Trauma 2013
- Update on Neuroimaging and Cognitive Functioning in Maltreatment-Related Pediatric PTSD: Treatment Implications JOURNAL OF FAMILY VIOLENCE 2013; 28 (1): 53-61
- Clinical Report: Psychological Maltreatment (vol 130, pg 372, 2012) PEDIATRICS 2012; 130 (4): 765-765
Can Traumatic Stress Alter the Brain? Understanding the Implications of Early Trauma on Brain Development and Learning
JOURNAL OF ADOLESCENT HEALTH
2012; 51 (2): S23-S28
Youth who experience traumatic stress and develop post-traumatic symptoms secrete higher levels of the glucocorticoid cortisol than youth with no trauma history. Animal research suggests that excess corticosterone secretion can lead to neurotoxicity in areas of the brain rich in glucocorticoid receptors such as the hippocampus and the prefrontal cortex (PFC). These two areas of the brain are involved in memory processing and executive function, both critical functions of learning.In this article, we summarize findings presented at the National Summit for Stress and the Brain conducted at Johns Hopkins University's Department of Public Health in April 2011. The presentation highlighted structural and functional imaging findings in the hippocampus and PFC of youth with post-traumatic stress symptoms (PTSS).Youth with PTSS have higher levels of cortisol. Prebedtime cortisol levels predict decreases in hippocampal volume longitudinally. Cortisol levels are negatively correlated with volume in the PFC. Functional imaging studies demonstrate reduced hippocampal and PFC activities on tasks of memory and executive function in youth with PTSS when compared with control subjects.Effective interventions for youth with PTSS should target improved function of frontolimbic networks. Treatment outcome research using these potential markers can help develop more focused interventions that target the impaired learning of vulnerable youth experiencing traumatic stress.
View details for DOI 10.1016/j.jadohealth.2012.04.010
View details for PubMedID 22794529
Posttraumatic Stress Disorder Shifting Toward a Developmental Framework
CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA
2012; 21 (3): 573-?
This article reviews the current classification of posttraumatic stress disorder and its limitations when applied to youth. Distinctions are made between single-event and multiple-event traumas. Diagnosis, neurobiology, treatment development, and treatment outcomes are presented. A summary of current empirical interventions is provided. The authors present implications for future research and for clinical practice.
View details for DOI 10.1016/j.chc.2012.05.004
View details for PubMedID 22800995
BRAIN ACTIVATION TO FACIAL EXPRESSIONS IN YOUTH WITH PTSD SYMPTOMS
DEPRESSION AND ANXIETY
2012; 29 (5): 449-459
This study examined activation to facial expressions in youth with a history of interpersonal trauma and current posttraumatic stress symptoms (PTSS) compared to healthy controls (HC).Twenty-three medication-naive youth with PTSS and 23 age- and gender-matched HC underwent functional magnetic resonance imaging (fMRI) while viewing fearful, angry, sad, happy, and neutral faces. Data were analyzed for group differences in location of activation, as well as timing of activation during the early versus late phase of the block. Using SPM5, significant activation (P < .05 FWE [Family-Wise Error] corrected, extent = 10 voxels) associated with the main effect of group was identified. Activation from selected clusters was extracted to SPSS software for further analysis of specific facial expressions and temporal patterns of activation.The PTSS group showed significantly greater activation than controls in several regions, including the amygdala/hippocampus, medial prefrontal cortex, insula, and ventrolateral prefrontal cortex, and less activation than controls in the dorsolateral prefrontal cortex (DLPFC). These group differences in activation were greatest during angry, happy, and neutral faces, and predominantly during the early phase of the block. Post hoc analyses showed significant Group × Phase interactions in the right amygdala and left hippocampus.Traumatic stress may impact development of brain regions important for emotion processing. Timing of activation may be altered in youth with PTSS.
View details for DOI 10.1002/da.21892
View details for PubMedID 22553009
- Treatment of Traumatic Stress Disorder in Children and Adolescents Psychiatric Times 2012; 29: 1-8
- Development of a Child Psychopharmacology Trial Scale Current Psychopharmacology 2012; 1 (1): 9-13
The impact of adverse childhood experiences on an urban pediatric population
CHILD ABUSE & NEGLECT
2011; 35 (6): 408-413
The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community.Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were coded and each ACE criterion endorsed by a traumatic event received a score of 1 (range=0-9). This study reports on the prevalence of various ACE categories in this population, as well as the association between ACE score and two pediatric problems: learning/behavior problems and body mass index (BMI)≥85% (i.e., overweight or obese).The majority of subjects (67.2%, N=471) had experienced 1 or more categories of adverse childhood experiences (ACE≥1) and 12.0% (N=84) had experienced 4 or more ACEs (ACE≥4). Increased ACE scores correlated with increased risk of learning/behavior problems and obesity.There was a significant prevalence of endorsed ACE categories in this urban population. Exposure to 4 or greater ACE categories was associated with increased risk for learning/behavior problems, as well as obesity.Results from this study demonstrate the need both for screening of ACEs among youth in urban areas and for developing effective primary prevention and intervention models.
View details for DOI 10.1016/j.chiabu.2011.02.006
View details for Web of Science ID 000292351200004
View details for PubMedID 21652073
View details for PubMedCentralID PMC3119733
- Reply to: Cortisol and Brain: Beyond the Hippocampus Biological Psychiatry 2011; 69 (4): e11
Decreased Prefrontal Cortical Volume Associated with Increased Bedtime Cortisol in Traumatized Youth
2010; 68 (5): 491-493
The purpose of this study was to investigate prefrontal cortex (PFC) volumes in youth with posttraumatic stress symptoms (PTSS) and explore the relationship between cortisol secretion and PFC volumes.Total brain tissue volumes, segmented areas of the PFC, and diurnal cortisol secretion were examined in a sample of 33 youth aged 10 to 16 years. Cerebral volumes were available for 45 subjects (30 PTSS and 15 control subjects).Youth with PTSS had significantly decreased total brain tissue and total cerebral gray volumes in comparison with healthy control subjects. While controlling for total cerebral gray volume, the PTSS group demonstrated decreased left ventral and left inferior prefrontal gray volumes. A significant negative association was found between prebedtime cortisol levels and left ventral PFC gray volumes for the full sample.Findings suggest associations between posttraumatic stress and PFC neurodevelopment. Findings also suggest a link between PFC development and cortisol secretion.
View details for DOI 10.1016/j.biopsych.2010.05.010
View details for PubMedID 20579974
- Natural disasters and the neurodevelopmental response to trauma in childhood: a brief overview and call to action FUTURE NEUROLOGY 2010; 5 (5): 667–74
Reduced Hippocampal Activity in Youth with Posttraumatic Stress Symptoms: An fMRI Study
JOURNAL OF PEDIATRIC PSYCHOLOGY
2010; 35 (5): 559-569
Youth who experience interpersonal trauma and have posttraumatic stress symptoms (PTSS) develop cognitive deficits that impact their development. Our goal is to investigate the function of the hippocampus in adolescents with PTSS during a memory processing task.Twenty-seven adolescents between the ages of 10-17 years (16 with PTSS and 11 healthy controls) encoded and retrieved visually presented nouns (Verbal Declarative Memory Task) while undergoing fMRI scanning.The PTSS group demonstrated reduced activation of the right hippocampus during the retrieval component of the task. Further, severity of symptoms of avoidance and numbing correlated with reduced left hippocampal activation during retrieval.Decreased activity of the hippocampus during a verbal memory task may be a neurofunctional marker of PTSS in youth with history of interpersonal trauma. The results of this study may facilitate the development of focused treatments and may be of utility when assessing treatment outcome for PTSS.
View details for DOI 10.1093/jpepsy/jsp112
View details for PubMedID 19995868
Heightened Amygdala and Hippocampal Responsivity to Emotional Faces in Youth with Posttraumatic Stress Disorder Symptoms: An fMRI Study.
ELSEVIER SCIENCE INC. 2010: 119S
View details for Web of Science ID 000277064200382
Treatment manual for trauma-exposed youth: case studies.
Clinical child psychology and psychiatry
2010; 15 (1): 27-38
Witnessing community violence and experiencing abuse in the home are two examples of interpersonal trauma that can have a devastating impact on children and adolescents. Recent research on the treatment of children exposed to interpersonal violence has focused on cognitive-behavioral interventions, often delivered in school settings. We describe the application of a new manual-based psychotherapy protocol for treating pediatric trauma in a middle school. Two case studies illustrate the protocol application to children from an inner-city neighborhood. The Stanford Cue-Centered Therapy (CCT) is a short-term, multimodal therapy for youths who have experienced trauma, focusing primarily on exposure to trauma-related cues. These cases provide early data on the feasibility and effectiveness of providing CCT for high-risk youth within a school setting and training of school mental-health personnel in the use of the Stanford CCT Manual.
View details for DOI 10.1177/1359104509338150
View details for PubMedID 19914939
- Natural disasters and the neurodevelopmental response to trauma in childhood: a brief overview and call to action Future Neurology 2010; 5: 667-674
Converging evidence for abnormalities of the prefrontal cortex and evaluation of midsagittal structures in pediatric posttraumatic stress disorder: An MRI study
2009; 172 (3): 226-234
Volumetric imaging research has shown abnormal brain morphology in posttraumatic stress disorder (PTSD) when compared with control subjects. We present results on a study of brain morphology in the prefrontal cortex (PFC) and midline structures, via indices of gray matter volume and density, in pediatric PTSD. We hypothesized that both methods would demonstrate aberrant morphology in the PFC. Further, we hypothesized aberrant brainstem anatomy and reduced corpus callosum volume in children with PTSD. Twenty-four children (aged 7-14) with history of interpersonal trauma and 24 age- and gender-matched controls underwent structural magnetic resonance imaging (sMRI). Images of the PFC and midline brain structures were first analyzed using volumetric image analysis. The PFC data were then compared with whole brain voxel-based techniques using statistical parametric mapping (SPM). The PTSD group showed significantly increased gray matter volume in the right and left inferior and superior quadrants of the PFC and smaller gray matter volume in the pons and posterior vermis areas by volumetric image analysis. The voxel-by-voxel group comparisons demonstrated increased gray matter density mostly localized to ventral PFC as compared with the control group. Abnormal frontal lobe morphology, as revealed by separate-complementary image analysis methods, and reduced pons and posterior vermis areas are associated with pediatric PTSD. Voxel-based morphometry may help to corroborate and further localize data obtained by volume of interest methods in PTSD.
View details for DOI 10.1016/j.pscychresns.2008.07.008
View details for PubMedID 19349151
Brief Report: Diurnal Salivary Cortisol in YouthClarifying the Nature of Posttraumatic Stress Dysregulation
JOURNAL OF PEDIATRIC PSYCHOLOGY
2009; 34 (4): 389-395
The purpose of this study was to clarify the nature of diurnal salivary cortisol dysregulation in youth who experience posttraumatic stress (PTS).Diurnal trends in salivary cortisol secretion were examined in a sample of 41 youth aged 10-16 years (26 youth exposed to interpersonal traumas and 15 control participants with no PTS) using hierarchical linear modeling.Cortisol levels were characterized by curvilinear trends in secretion (i.e., sharp declines from prebreakfast to prelunch followed by smaller decreases from prelunch to predinner with a leveling-off or slight increase from predinner to prebed assessment). Results further indicated that youth with PTS had sharper morning declines and relatively higher evening levels (i.e., a greater curve in the daily trend) than nontraumatized youth.Findings help to elucidate the physiological basis for altered arousal patterns in youth with PTS. Traumatized youth showed wider daily fluctuations in cortisol levels when these trends were modeled in a curvilinear fashion. The findings help to describe the nature of stress dysregulation in trauma-exposed youth and may have implications for clarifying some of the apparent inconsistencies in the literature.
View details for DOI 10.1093/jpepsy/jsn087
View details for Web of Science ID 000265525600006
View details for PubMedID 18689854
View details for PubMedCentralID PMC2722130
Guilt and posttraumatic stress symptoms in child victims of interpersonal violence.
Clinical child psychology and psychiatry
2009; 14 (1): 71-83
Our objective was to examine the relationship between guilt and posttraumatic stress disorder (PTSD) symptoms in children with a history of interpersonal violence. Eighty-seven children between the ages of 5 and 16 years (mean age = 11.70 years) were administered the Clinician-Administered PTSD Scale for Children and Adolescents to assess for PTSD symptoms and associated features. Multiple regression analysis found that guilt over acts of commission or omission (behaviors the child performed or failed to perform during the event or to prevent it) was highly associated with PTSD severity. Derealization and changes in attachment were also significantly related to PTSD symptoms. Findings suggest that it may be important for clinicians to assess for associated features in traumatized children as these are associated with greater PTSD severity. Posttraumatic interventions may benefit from targeting these symptoms.
View details for DOI 10.1177/1359104508100137
View details for PubMedID 19103706
- Loss and the Experience of Emotional Distress in Childhood JOURNAL OF LOSS & TRAUMA 2009; 14 (1): 1-16
Posttraumatic stress symptoms and brain function during a response-inhibition task: An fMRI study in youth
DEPRESSION AND ANXIETY
2008; 25 (6): 514-526
Youth who experience interpersonal trauma and have posttraumatic stress symptoms (PTSS) can exhibit difficulties in executive function and physiological hyperarousal. Response inhibition has been identified as a core component of executive function. In this study, we investigate the functional neuroanatomical correlates of response inhibition in youth with PTSS. Thirty right-handed medication-naïve youth between the ages of 10 and 16 years underwent a 3-Tesla Functional Magnetic Resonance Imaging scan during a response-inhibition (Go/No-Go) task. Youth with PTSS (n = 16) were age and gender matched to a control group of healthy youth (n = 14). Between-groups analyses were conducted to identify brain regions of greater activation in the No/Go-Go contrasts. PTSS and control youth performed the task with similar accuracy and response times. Control subjects had greater middle frontal cortex activation when compared with PTSS subjects. PTSS subjects had greater medial frontal activation when compared with control subjects. A sub-group of youth with PTSS and a history of self-injurious behaviors demonstrated increased insula and orbitofrontal activation when compared with those PTSS youth with no self-injurious behaviors. Insula activation correlated positively with PTSS severity. Diminished middle frontal activity and enhanced medial frontal activity during response-inhibition tasks may represent underlying neurofunctional markers of PTSS.
View details for DOI 10.1002/da.20346
View details for PubMedID 17598145
The psychosocial impact of Hurricane Katrina: Contextual differences in psychological symptoms, social support, and discrimination
BEHAVIOUR RESEARCH AND THERAPY
2007; 45 (10): 2295-2306
This study tested a contextual model of disaster reaction by examining regional differences in the psychosocial impact of Hurricane Katrina. A total of 386 individuals participated in this study. All were recruited in the primary areas affected by Hurricane Katrina and included residents of metropolitan New Orleans (Orleans Parish, Louisiana), Greater New Orleans (i.e., Metairie, Kenner, Gretna), and the Mississippi Gulf Coast (i.e., cities along the coast from Waveland to Ocean Springs, Mississippi). Participants were assessed for posttraumatic stress disorder (PTSD) symptoms, other psychological symptoms, perceptions of discrimination, perceptions of social support, evacuation distance, and the extent to which they experienced hurricane-related stressful events. Results were consistent with previous research on the impact of disasters on mental health symptoms. Findings extended research on individual differences in the response to trauma and indicated that regional context predicted unique variance in the experience of discrimination, social support, and emotional symptoms consistent with the theoretical model presented.
View details for DOI 10.1016/j.brat.2007.04.013
View details for Web of Science ID 000250038600004
View details for PubMedID 17568560
The association between PTSD symptoms and salivary cortisol in youth: The role of time since the trauma
JOURNAL OF TRAUMATIC STRESS
2007; 20 (5): 903-907
This study examined the direction of association between symptoms of posttraumatic stress disorder (PTSD) and cortisol levels among youth with recent and distal traumas (N = 50; mean age = 10.7 years). Each had a clinical interview for PTSD symptoms, a cortisol assessment, and the time since the child's most recent trauma was assessed. Results indicated that the time since the most recent trauma moderated the association between cortisol and PTSD symptoms and comparisons indicated that there were significant differences in the size of the correlations across the recent and distal trauma groups. The results point to a potentially important role of the time since trauma in understanding the relationship between PTSD symptoms and cortisol.
View details for DOI 10.1002/jts.20251
View details for Web of Science ID 000250736400024
View details for PubMedID 17955527
Divalproex sodium for the treatment of PTSD and conduct disordered youth: A pilot randomized controlled clinical trial
CHILD PSYCHIATRY & HUMAN DEVELOPMENT
2007; 38 (3): 183-193
We examined the efficacy of divalproex sodium (DVP) for the treatment of PTSD in conduct disorder, utilizing a previous study in which 71 youth were enrolled in a randomized controlled clinical trial. Twelve had PTSD. Subjects (all males, mean age 16, SD 1.0) were randomized into high and low dose conditions. Clinical Global Impression (CGI) ratings for core PTSD symptoms (Intrusion, avoidance and hyper arousal) were primary outcome measures, weekly slopes of impulsivity secondary ones. Intent-to-treat analyses showed significant positive associations between receiving high dose of DVP CGI's. Parallel analyses comparing outcome by drug level achieved strengthened the results.
View details for DOI 10.1007/s10578-007-0055-8
View details for PubMedID 17570057
State and trait emotions in delinquent adolescents
CHILD PSYCHIATRY & HUMAN DEVELOPMENT
2007; 38 (2): 155-169
To examine the structure of emotions and affective dysregulation in juvenile delinquents.Fifty-six juvenile delinquents from a local juvenile hall and 169 subjects from a local high school were recruited for this study. All participants completed psychometric testing for trait emotions followed by measurements of state emotions under two conditions (free association and stress condition). Finally, delinquent participants completed a detailed assessment of past trauma using the Childhood Trauma Interview (CTI).Delinquents exhibit significantly higher levels of negative state and trait emotions when compared to a high school sample. In the delinquent sample chronicity of physical trauma affects the longstanding variable of trait emotionality and severity of trauma, specifically emotional abuse and witnessing violence, shapes negative emotional outcomes in state emotionality. In addition, delinquents appear to experience a wider range of emotions than the comparison sample and were more likely to experience a confluence of state emotions of sadness and anger under stressed conditions.Adolescent delinquents appear to have a different experience of negative emotions than comparison adolescents. The experience of emotions appears to differ in state and trait conditions. These emotions may be related to childhood experiences of trauma.
View details for Web of Science ID 000247265400006
View details for PubMedID 17417724
Stress predicts brain changes in children: A pilot longitudinal study on youth stress, posttraumatic stress disorder, and the hippocampus
2007; 119 (3): 509-516
Does stress damage the brain? Studies of adults with posttraumatic stress disorder have demonstrated smaller hippocampal volumes when compared with the volumes of adults with no posttraumatic stress disorder. Studies of children with posttraumatic stress disorder have not replicated the smaller hippocampal findings in adults, which suggests that smaller hippocampal volume may be caused by neurodevelopmental experiences with stress. Animal research has demonstrated that the glucocorticoids secreted during stress can be neurotoxic to the hippocampus, but this has not been empirically demonstrated in human samples. We hypothesized that cortisol volumes would predict hippocampal volume reduction in patients with posttraumatic symptoms.We report data from a pilot longitudinal study of children (n = 15) with history of maltreatment who underwent clinical evaluation for posttraumatic stress disorder, cortisol, and neuroimaging.Posttraumatic stress disorder symptoms and cortisol at baseline predicted hippocampal reduction over an ensuing 12- to 18-month interval.Results from this pilot study suggest that stress is associated with hippocampal reduction in children with posttraumatic stress disorder symptoms and provide preliminary human evidence that stress may indeed damage the hippocampus. Additional studies seem to be warranted.
View details for DOI 10.1542/peds.2006-2028
View details for PubMedID 17332204
IQ and posttraumatic stress symptoms in children exposed to interpersonal violence
CHILD PSYCHIATRY & HUMAN DEVELOPMENT
2006; 36 (3): 261-272
The literature is mixed as to the relationship between intelligence quotient (IQ) and Posttraumatic Stress Disorder (PTSD) symptomatology in adult populations. Even less is known about the relationship in children who have been traumatized.Fifty-nine children and adolescents (mean age = 10.6) with a history of interpersonal violence were evaluated with respect to PTSD symptomatology, number of traumas, and estimated Verbal, Performance and Full scale IQ scores. PTSD symptomatology included symptom levels for cluster B (re-experiencing), cluster C (avoidance and numbing), and cluster D (Hypervigilance) and criterion F, functional impairment.Results indicated that Full scale and Verbal IQ were significantly associated with the number of traumas, re-experiencing symptoms, and impairment. Performance IQ was only associated with impairment. Regression analyses suggested that together PTSD symptomatology predicted Full scale and Verbal IQ but nor Performance IQ and impairment was the single best predictor of IQ generally.Findings provide support for an association between PTSD symptoms and IQ, particularly verbal IQ. Two possible reasons for this relationship are that higher levels of Verbal IQ may serve as a premorbid protective factor against the development of re-experiencing symptoms, or performance on post-trauma Verbal IQ measures may be negatively impacted by expression of PTSD symptoms. Longitudinal studies are needed to clarify which of these two possibilities explains the association.
View details for DOI 10.1007/s10578-005-0002-5
View details for PubMedID 16362242
Mixed lateral preference in posttraumatic stress disorder
JOURNAL OF NERVOUS AND MENTAL DISEASE
2006; 194 (2): 142-144
Recent research indicates that adults with posttraumatic stress disorder (PTSD) have a higher incidence of mixed laterality with respect to handedness than the rest of the population. To test if this relationship also occurs early in life, we evaluated children with history of interpersonal trauma. Fifty-nine traumatized children were evaluated with the Clinician Administered PTSD Scale for Children and Adolescents and the Edinburgh Handedness Inventory. Forty matched healthy controls were used for comparison. Increased mixed laterality was found in all children exhibiting symptoms of PTSD when compared with healthy controls, and children who met DSM-IV diagnostic criteria for PTSD had more mixed laterality than the subthreshold traumatized group (F = 7.71; df = 2,96; p = 0.001). Within the entire traumatized group, there was a positive correlation between PTSD symptom severity and mixed laterality. Mixed laterality was positively associated with PTSD symptoms in traumatized children, suggesting that neurological abnormalities may be related to degree of PTSD symptom expression.
View details for DOI 10.1097/01.nmd.0000198201.59824.37
View details for PubMedID 16477196
Regional differences of the prefrontal cortex in pediatric PTSD: an MRI study
DEPRESSION AND ANXIETY
2006; 23 (1): 17-25
Previous studies have revealed altered structural development of the frontal lobes and prefrontal cortex (PFC) in children with symptoms of posttraumatic stress disorder (PTSD). This study is the first to provide a detailed structural analysis of the PFC in children with and without PTSD symptoms. We compared gray and white matter volume in four subregions of the PFC between said groups, then explored whether volume was associated with PTSD symptom severity and functional impairment. PFC measurements were extracted from magnetic resonance imaging (MRI) data from a sample of 23 children (ages 7-14) with a history of trauma and symptoms of PTSD, who had undergone assessment for PTSD symptoms and functional impairment using the Child and Adolescent version of the Clinician-Administered PTSD Scale (CAPS-CA). These measurements were compared to data from an age-equivalent control group of 24 healthy children. Children with PTSD symptoms showed a significantly larger volume of gray matter in the delineated middle-inferior and ventral regions of the PFC than did control children. Decreased volume of gray matter in the dorsal PFC correlated with increased functional impairment scores. Results indicate that increased volume of the middle-inferior and ventral PFC may be associated with trauma and PTSD symptoms in children. Furthermore, the neuroanatomy of the dorsal PFC may influence the degree of functional impairment experienced by children with PTSD symptoms.
View details for DOI 10.1002/da.20131
View details for PubMedID 16247760
Development of anxiety disorders in a traumatized pediatric population: A preliminary longitudinal evaluation
CHILD ABUSE & NEGLECT
2005; 29 (8): 905-914
The current study was conducted to determine if post-traumatic stress disorder (PTSD) symptomatology predicted later development of non-PTSD anxiety disorders in children and adolescents victimized by interpersonal trauma.Thirty-four children with a history of interpersonal trauma and no initial diagnosis of anxiety disorder participated in the study. Children were assessed at time one (T1) and then 12-18 months later at time two (T2). At T1, the Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA) and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) were used to evaluate children's PTSD symptoms and comorbid non-PTSD anxiety disorder diagnosis. At T2, the CAPS-CA and the K-SADS-PL were repeated.The diagnosis of PTSD and PTSD symptoms in children exposed to interpersonal trauma at T1, particularly the symptoms associated with avoidance and constricted emotional expression (criteria C) as well as physiological hyperarousal (criteria D), predicted the development of other anxiety disorders at T2.Traumatized children with initial PTSD symptomatology may be at risk of later development of other anxiety disorders.
View details for DOI 10.1016/j.chiabu.2004.12.010
View details for Web of Science ID 000231777500005
View details for PubMedID 16125233
Relationships of dissociation and childhood abuse and neglect with heart rate in delinquent adolescents
JOURNAL OF TRAUMATIC STRESS
2004; 17 (1): 47-54
This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.
View details for PubMedID 15027793
An ecological-transactional model of significant risk factors for child psychopathology in outer Mongolia
CHILD PSYCHIATRY & HUMAN DEVELOPMENT
2004; 35 (2): 163-181
The present study examined significant risk factors, including child maltreatment, for child psychopathology in a cross-cultural setting. Ninety-nine Mongolian boys, ages 3-10 years, were assessed. Primary caregivers (PCG) completed structured interviews including the Emory Combined Rating Scale (ECRS) and the Mood and Feelings Questionnaire (MFQ). Structural equation modeling identifies eight risk factors affecting child psychopathology: Three with direct effects (severity of physical punishment, PCG's MFQ score, and PCG's education), three with indirect effects (cultural acceptance of violence as discipline, presence of community violence, and contact with extended family), and two with direct and indirect effects (quality of marriage/presence of spousal abuse, and household size). Results support the ecological-transactional theory of developmental psychopathology in a cross-cultural setting. Structural equation modeling provides a useful technique to isolate specific sites for intervention, while maintaining a comprehensive perspective of risk factor interaction.
View details for PubMedID 15577280
Pathways to dissociation: Intrafamilial versus extrafamilial trauma in juvenile delinquents
JOURNAL OF NERVOUS AND MENTAL DISEASE
2003; 191 (12): 781-788
Dissociation is postulated to occur as a function of particular types of child abuse or chronic abuse. Additionally, there is an ongoing controversy examining the perpetrator's relationship to the victim in the development of dissociation. In this study, reports of traumatic events experienced both in the family environment and in the community were used to examine the relationship between dissociative disorder as defined by DSM-IV (pathological dissociation), and dissociation as a defense mechanism. The first objective was to identify whether the site of the trauma or the quantity of trauma correlated more significantly with symptoms of dissociation. The second objective was to explore a potential correlation between topics that participants choose to disclose during a standardized Stress Inducing Speech Task (SIST), and symptoms of dissociation. The third objective was to examine the relationship between the age of occurrence, the duration of trauma, and symptoms of dissociation. Fifty-two delinquent juveniles completed measures (including the SCID-D, REM-71, CTQ, CTI, SIST) assessing traumatic experiences, psychopathological dissociation, and dissociation as defense mechanism. Blind raters scored the SIST for intrafamilial and extrafamilial trauma. The perpetrator's relationship to the victim, site of the trauma, quantity of the trauma, age of occurrence, and duration of the trauma were analyzed by descriptive statistics and Pearson partial correlations. Significant correlations were found between symptoms of pathological dissociation and intrafamilial trauma. Significant correlations were not found between extrafamilial trauma and pathological dissociation and dissociation as defense mechanism. All these correlations held constant the chronicity of traumas reported. The results obtained in this study through blind and independent assessment suggest that special trauma characteristics (i.e., childhood trauma perpetrated by a family member) rather than sheer cumulative effects of trauma may have greater implications for the development of pathological dissociation. The relationships to dissociation as a defense were much weaker.
View details for DOI 10.1097/01.nmd.0000105372.88982.54
View details for Web of Science ID 000187438200003
View details for PubMedID 14671454
Dissociative symptoms in posttraumatic stress disorder: diagnosis and treatment
CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA
2003; 12 (2): 231-?
This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.
View details for DOI 10.1016/S1056-4993(02)00103-7
View details for PubMedID 12725010
A prospective test of the association between hyperarousal and emotional numbing in youth with a history of traumatic stress
JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY
2003; 32 (1): 166-171
Investigated the hypothesis that emotional numbing may develop as a result of hyperarousal using a prospective design. Forty-two children between the ages of 7 and 14 with a history of trauma and posttraumatic stress disorder (PTSD) symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA; Nader et al., 1996) and were reassessed 1 year later. Results indicated that hyperarousal symptoms were concurrently positively correlated with emotional numbing at both time points. Moreover, Time 1 hyperarousal symptoms were associated with emotional numbing at Time 2 and predicted Time 2 emotional numbing even when controlling for each of the other symptom clusters of PTSD at Time 1 as well as other concurrent (i.e., Time 2) PTSD symptoms. Results are discussed in terms of the implications of the findings for enhancing the understanding of PTSD symptoms in youth.
View details for Web of Science ID 000180579800015
View details for PubMedID 12573941
- The treatment of separation anxiety disorder employing attachment theory and cognitive behavior therapy techniques Clin Case Studies 2003; 2 (3): 188-198
Diurnal salivary cortisol in pediatric posttraumatic stress disorder
2002; 51 (7): 575-582
The hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the pathophysiology of posttraumatic stress disorder (PTSD). Additional information on basal cortisol levels in children exposed to trauma and experiencing PTSD symptoms may contribute to the understanding of the role of this axis in PTSD.Fifty-one children (30 boys and 21 girls, mean age 10.7 years) with a history of exposure to trauma and PTSD symptoms were compared with 31 age- and gender-matched healthy control subjects. Salivary cortisol was obtained from participants during home measurements and was collected four times a day (prebreakfast, prelunch, predinner, and prebed) for up to 3 consecutive days.The clinical group demonstrated significantly elevated cortisol levels when compared with the control group. In addition, exploratory analyses revealed that girls with PTSD symptoms had significantly elevated cortisol levels when compared with boys with PTSD symptoms.The physiologic response of children with history of trauma and with PTSD symptoms may be characterized by heightened adrenal activity.
View details for PubMedID 11950459
Toward an empirical definition of pediatric PTSD: The phenomenology of PTSD symptoms in youth
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
2002; 41 (2): 166-173
To examine the frequency and intensity of posttraumatic stress disorder (PTSD) symptoms and their relation to clinical impairment, to examine the requirement of meeting all DSM-IV symptom cluster criteria (i.e., criteria B, C, D), and to examine the aggregation of PTSD symptom clusters across developmental stages.Fifty-nine children between the ages of 7 and 14 years with a history of trauma and PTSD symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents.Data support the utility of distinguishing between the frequency and the intensity of symptoms in the investigation of the phenomenology of pediatric PTSD. Children fulfilling requirements for two symptom clusters did not differ significantly from children meeting all three cluster criteria with regard to impairment and distress. Reexperience (cluster B) showed increased aggregation with avoidance and numbing (cluster C) and hyperarousal (cluster D) in the later stages of puberty.Frequency and intensity of symptoms may both contribute to the phenomenology of pediatric PTSD. Children with subthreshold criteria for PTSD demonstrate substantial functional impairment and distress.
View details for PubMedID 11837406
Attenuation of frontal asymmetry in pediatric posttraumatic stress disorder
2001; 50 (12): 943-951
Volumetric imaging research has shown abnormal brain morphology in adults with posttraumatic stress disorder (PTSD) when compared with matched control subjects. In this article, we present brain imaging findings from a study of children with PTSD symptoms.Twenty-four children between the ages of 7 and 14 with a history of trauma and PTSD symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). The sample underwent magnetic resonance imaging in a 1.5 T scanner. Brain images were analyzed by raters blind to diagnostic status using well-standardized methods, and images were compared with age- and gender-matched healthy control subjects.The clinical group demonstrated attenuation of frontal lobe asymmetry and smaller total brain and cerebral volumes when compared with the control group. There were no statistically significant differences in hippocampal volume between clinical and control subjects.Frontal lobe abnormalities may occur as a result of PTSD in children or, alternatively, be a risk factor for the development of the syndrome in this age group. The implications of the findings and their consistency with previous research are discussed.
View details for PubMedID 11750890
Trauma and dissociation in delinquent adolescents
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
2000; 39 (3): 353-359
To assess history of trauma and dissociation in a group of juvenile delinquents and to assess how adolescents would respond to a structured interview for dissociative symptoms.Sixty-four adolescents in juvenile probation hall participated in 2 investigational sessions in 1996-1997. For session 1 they answered the Childhood Trauma Questionnaire (CTQ), the Response Evaluation Measure for Youth-71 (REMY-71), and the Weinberger Adjustment Inventory. For session 2 they were given the Childhood Trauma Interview (CTI) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D).In this sample 28.3% met criteria for a dissociative disorder and 96.8% endorsed a history of traumatic events. There were significant positive correlations between CTI and CTQ trauma scores and SCID-D and REMY-71 dissociative symptoms. All dissociative symptoms were endorsed, but depersonalization was the most common experience. There was a lack of congruence between the different methods of assessing dissociation.This study provides support for an early link between history of trauma and dissociation. Adolescents were able to answer questions from a structured interview assessing dissociation.
View details for Web of Science ID 000085580800018
View details for PubMedID 10714056
- The coming out process: developmental stages for sexual minority youth Clin Child Psychol and Psychiatry 1997; 2 (3): 369-377
- NALTREXONE FOR THE TREATMENT OF TRICHOTILLOMANIA - A CASE-REPORT JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY 1995; 15 (6): 444-445
ROADBLOCKS TO DO-NOT-RESUSCITATE ORDERS - A STUDY IN POLICY IMPLEMENTATION
ARCHIVES OF INTERNAL MEDICINE
1993; 153 (14): 1689-1695
Cardiopulmonary resuscitation, a potentially lifesaving procedure, is initiated on hospitalized patients who have an arrest in the absence of a written do-not-resuscitate (DNR) order. New York State Law specifies that attending physicians may write a DNR order on an adult patient either with his/her consent or that of a surrogate. Under specified circumstances, concurring physician and witness signatures are also required. This study examines potential obstacles physicians may encounter when implementing a DNR order for a hospitalized patient.Sixty house staff officers and 45 attending physicians at two New York City medical centers responded to a questionnaire listing 18 potential problems in obtaining a DNR order. Using a Likert scale, respondents rated the prevalence of each problem.Analysis of the data indicates that attending physician's failure to discuss DNR issues with patients and situations involving surrogate decision making are considered major obstacles to obtaining a DNR order. Procedural regulations, including abundant paperwork and witnessed signatures, are not identified as major obstacles.This study suggests a need for improved communication among physicians, patients, and surrogates about advance directives, when feasible, either prior to hospitalization or early in its course, in an effort to comply with DNR legislation in a manner that reflects the patient's wishes and best interests.
View details for Web of Science ID A1993LP29900007
View details for PubMedID 8333806